Self-employed fishers prepare for ACA mandate

As the March 31 deadline for the individual insurance mandate under the Affordable Care Act nears, Alaska’s fishers are still navigating the changes.

“My sense is, a lot of fishermen are still in a wait and see mode,” said United Fishermen of Alaska Executive Adminstrator Mark Vinsel.

Fishermen and charter operators are often self-employed, and the mandate for Americans to procure health insurance will directly affect them.

Officially, the mandate went into affect in January, but enrollment through the new health insurance exchanges is available until March 31, and penalties will not be assessed for those who enroll by that date. Those that don’t enroll will face a tax penalty.

According to a 2009 study by the Small Business Majority, a California-based advocacy group that includes former Alaska state Rep. Terry Gardiner on its staff, 32 percent of commercial fishermen did not have health insurance coverage in 2009, based on a survey of 100 commercial fishermen.

At the time, 72 percent of the fishermen who didn’t have coverage said they couldn’t afford it, and 40 percent said they were struggling to pay for it.

Vinsel said that historically, it can be difficult for fishermen to access health insurance and health care, both because of the logistics of their employment and the logistics of where they work — away from roads and hospitals.

UFA did its own study prior to the SBM study, and found that the lack of health insurance was a barrier for new individuals considering entering the sector, and also a concern for the majority those who man the fishing fleet who are aging.

Now, however, a lot of self-employed folks seem generally pleased with the coverage, Vinsel said.

That’s true for George Meintel and Cynthia Wallesz, salmon gillnetters who live in Petersburg.

Meintel said the plan they found through the new health insurance exchange was cheaper, and provided better coverage, than their old plan.

Meintel and Wallesz, his wife, have a joint policy. Previously, they purchased a policy independently, and a significant chunk of their income went toward health insurance that primarily covered catastrophic incidents. The new plan has some limits on what providers they can use, but generally provides better coverage, Meintel said.

“It was a big pain to wade through the process, and the process is far from perfect,” he said.

Ultimately, however, they saved about 80 percent on better insurance.

“As a self-employed fisherman, I had a multitude of choices, which I’ve never had in the past,” Meintel said.

The old plan was still available after the ACA changes went into affect, but the new plan was a better price and offered better coverage, so they switched.

They also benefited from the subsidies available through the exchange. Meintel calculated their income based on an average of the last three years of fishing, and then estimated a little higher.

“Commercial fishermen aren’t the richest guys in the world,” he said.

Meintel said he was impressed by how things worked out, and told other fishing friends to try for themselves to make sure it wasn’t a fluke. They had similar experiences, he said.

Despite some success stories, not everything has been smooth sailing.

Northrim Benefits Enroll Alaska has done outreach throughout the state to educate people about the changes, including working with fishing groups.

Chief Operating Officer Tyann Boling said enrollment has been less than expected — both for fishermen, and in general, she said.

Fishers represent just a small portion of the total enrollment, she said.

Vinsel said he was impressed with Enroll Alaska’s efforts, particularly in the fall when the federally-run exchange website wasn’t even working.

Boling said her group had done education events with a couple fishing groups, including a presentation to the United Fishermen of Alaska in Sitka last fall, and one at the Alaska Young Fishermen’s Summit in Anchorage this winter. She’ll also attend the annual ComFish conference and trade show in Kodiak this spring.

“We have definitely been doing everything we can to get the message out,” Boling said.

Fishermen have largely been asking about the costs. There’s also been a lack of information about how the subsidies work, and questions about those, Boling said.

“Overall, it’s ‘what’s the cost going to be to me?’ and ‘what’s the tax penalty?’” Boling said.

The new exchange isn’t the only way fishermen get health insurance.

Many get health insurance through second jobs or family members who work a job with that provides insurance, Vinsel said. That isn’t as available in some coastal and rural communities as it is in Juneau, however, he said.

The state also administers the Alaska Fishermen’s Fund, which provides funds for the treatment and care of licensed commercial fishermen injured while fishing on shore or off shore in Alaska. The fund is financed from commercial fishermen’s license and permit fees.

Charter operators

Many charter operators are in a similar boat to commercial fishermen with respect to finding insurance before the coming deadline.

Steve Zernia operates ProFish-N-Sea Charters out of Seward, and his wife, Elle Zernia, also has a sport and commercial processing business, Captain Jack’s Seafood Locker.

Their experience with the new health care law hasn’t gone as smoothly.

For 2014, Zernia and his family — two adults and two kids are on the policy — will have the same plan as last year, because of the extension that allowed old, non-qualifying, plans to continue for another year.

Next year, however, the changes will affect them.

“Our deductibles would go up and our premium would go up,” Zernia said.

That’s because the old plan will go away, and they have to switch to a new one that meets all of the ACA plan requirements — even though some of the things the new plan provides aren’t services the family will use.

Zernia said his insurance agent, Premera Blue Cross, found the plan that was most comparable to the family’s old plan for them, and has largely taken care of the legwork.

Gerri Martin, who operates Homer’s North Country Charters with her husband, Sean Martin, has had a better experience. Martin said her new health care plan is the direct result of the plans made available by the Affordable Care Act.

She purchased it directly through the provider, Moda Health, and not the exchange, but said it was only available because the law expanded coverage for people with pre-existing conditions.

Martin and her husband both have pre-existing conditions — a pacemaker for him, asthma and a few non-cancerous lumpsectomies for her — but they’re generally healthy, she said.

“We’re super healthy and we ski every day and we travel,” Martin said.

From 1999 to 2012, they were insured under a Golden Rule plan. Then the company pulled out of Alaska. Health insurance was the family’s second biggest expense every year, after their mortgage payments.

“At that time, our premiums, oh my gosh, they were so expensive,” Martin said.

By the final year, that cost $32,592 per year for the two of them, plus one son, and they each had a $5,000 deductible, more than double what they paid as a family of four about a decade earlier — $9,501.

Because of their conditions, she couldn’t find another plan when Golden Rule left the state. They turned to Alaska Comprehensive Health Insurance Association, or ACHIA, which is run by the State of Alaska and provides coverage to high-risk individuals.

This year, the Martins would have paid $32,988 for just the two of them, again with the high deductible. Their son couldn’t be covered because he wasn’t high-risk.

But because those conditions must be covered under ACA, Martin found a better deal. She searched through the exchange to locate the plan, but ultimately purchased it directly from Moda, in part because of the issues with the health exchange website that many reported. Because she and her husband weren’t eligible for subsidies, they didn’t have to use the exchange.

“I went to Moda and I plugged everything in and I got insured almost instantly,” Martin said.

The Moda silver plan is $14,748 cheaper than what they would have paid under ACHIA, and the deductible is $2,500 each instead of $5,000 each.

Martin said her family has always been willing to buy insurance, and they have purchased it. The act leveled the playing field, however, and made it more accessible.

It also made the process much simpler, Martin said. Before she signed up for ACHIA, applying for health insurances required several pages of health history.

“Now the only health care questions are your age and whether you are a smoker or not, just as simple as that,” she wrote in an email.